12VAC30-120-395 - Preauthorized, emergency, and post-stabilization services and payment rate for care provided by out-of-network providers

12VAC30-120-395. Preauthorized, emergency, and post-stabilization services and payment rate for care provided by out-of-network providers

The MCOs shall pay for preauthorized, emergency, and post-stabilization services to members in compliance with the contract and 42 CFR 438.114. Preauthorized, emergency, and post-stabilization services provided to a managed care member by a provider or facility not participating in the MCO's network will be reimbursed according to the current Medicaid fee schedule. This reimbursement shall be considered payment in full to the provider or facility of emergency services.

(Derived from Virginia Register Volume 13, Issue 5, eff. January 1, 1997; amended, Virginia Register Volume 19, Issue 3, eff. December 1, 2002; Volume 19, Issue 23, eff. August 27, 2003; Amended, Virginia Register Volume 32, Issue 22, eff. 7/27/2016; Amended, Virginia Register Volume 35, Issue 14, eff. 4/18/2019.)

Statutory Authority: § 32.1-325 of the Code of Virginia; 42 USC § 1396 et seq.

The following state regulations pages link to this page.